Risk Prediction and Management for Central Nervous System Infection after Resection for Gliomas - The 8-Year Experience from a Tertiary Medical Center

Objective: Glioma surgery, involving manipulation of brain parenchyma, can lead to elevated levels of inflammatory molecules in the central nervous system and alterations in cerebrospinal fluid circulation, potentially increasing the risk of central nervous system infection (CNSI). However, research on risk factors, clinical characteristics, and predictive models for CNSI following glioma resection remains scarce. Methods: We studied 435 patients undergoing glioma resection at Peking Union Medical College Hospital (2015-2023), collecting demographic, clinical, surgical, laboratory, and survival data. We analyzed risk factors for postoperative CNSI, developed a predictive model, and summarized cerebrospinal fluid (CSF) characteristics and antibiotic use in CNSI patients. The impact of CNSI on long-term prognosis was also assessed. Results: Of 435 patients, 65 (14.9%) developed CNSI. After excluding 98 patients with missing data, 61 of 337 analyzed patients had postoperative CNSI. Independent risk factors included ventricular opening, postoperative systemic infection, maximum cavity diameter, and preoperative peripheral blood mononuclear cell percentage. A nomogram based on these factors showed good predictive performance (C statistic = 0.797) and was validated internally and externally (AUC = 0.731). Decision curve analysis indicated positive net benefits within a 0-30% risk threshold. CSF in CNSI patients showed elevated protein (median 1.73 g/L), decreased glucose (median 2.7 mmol/L), and increased white blood cells (median 1478 × 10^6 /L) with a high polymorphonuclear cell percentage (median 84.1%). Meropenem and vancomycin were the most used antibiotics, with average durations of 7.79 and 8.41 days, respectively. Survival analysis showed no impact of CNSI on long-term prognosis. Conclusions: This study identifies risk factors for CNSI following glioma resection and develops a predictive model, aiding clinical decision-making. Summarized CSF characteristics and antibiotic use provide diagnostic and treatment references for CNSI post-glioma surgery.